Provider Engagement Account Manager

Centene Corporation • Austin, TX

2d • $56,200 - $101,000

About The Position

This field-based position requires the individual to live in Austin. The Provider Engagement Account Manager maintains partnerships between the health plan and contracted provider networks serving the community, builds client relationships to support high-quality care for members, and engages providers on network performance opportunities and solutions. The role uses a consultative account-management approach and is accountable for resolving issues and driving performance in contract incentives, quality, cost, and utilization.

The position requires authorization to work in the United States without current or future employment-based visa sponsorship. Sponsorship is not available for this opportunity, including for H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT visa types. The role requires local travel four days per week.

Requirements

• Bachelor’s degree in a related field or equivalent experience.
• Two years of experience in managed care or a medical group, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations.
• Project management experience in a medical group, IPA, or health plan setting.
• Proficiency in HEDIS/quality measures, cost, and utilization.
• Must live in Austin.
• Must be authorized to work in the United States without the need for current or future employment-based visa sponsorship.
• Ability to travel locally four days per week.

Responsibilities

• Serve as the primary contact for providers and act as a liaison between providers and the health plan.
• Triage provider issues and coordinate resolution with internal partners.
• Receive and respond effectively to external provider-related issues.
• Investigate, resolve, and communicate provider claim issues and changes.
• Initiate data entry of provider demographic information changes.
• Educate providers on policies and procedures related to referrals, claims submission, website use, EDI solicitation, and related topics.
• Conduct provider orientations and ongoing provider education, including writing and updating orientation materials.
• Manage network performance for an assigned territory using a consultative account-management approach.
• Evaluate provider performance and develop strategic plans to improve it.
• Drive provider performance improvement in risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost, and utilization.
• Complete special projects as assigned.
• Perform other duties as assigned.
• Comply with all policies and standards.
• Travel locally four days per week.

Benefits

• Competitive pay
• Health insurance
• 401(k) and stock purchase plans
• Tuition reimbursement
• Paid time off and holidays
• Flexible approach to work schedules, including remote, hybrid, field, or office schedules

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level